To be completed by buyer! (Please use block letters)
●
In te vullen door de verkoper! (Graag in drukletters) ●
Vom Käufer auszufüllen!
(Bitte in Druckschrift) ● A remplir par l’acheteur! (en lettres d’imprimerie, s’il vous plaît) ● Da compilare dall’acquirente! (in stampatello) ●
¡Completa el cliente! (en mayúsculas) ● Fylles ut av kjøper! (Vær vennlig å bruke blokkbokstaver) ● Udfyldes af køber! (Benyt venligst
Blokbogstaver):
Place of purchase
● Plaats van aankoop ●
Bezugsquelle ● Source d’achat ● Acquistato presso
● Lugar de compra ● Salgssted ● Salgs sted:
……………………………………………………………
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Sales receipt No.
● Aankoopbewijs Nr. ●
Kaufbeleg-Nr. ● Récépissé n° ● Prova d’acquisto
N. ● Recibo N
o
● Kvitteringsnr ● Kasse Bon nr
.……..........................................................................
Delivery date
● Leveringsdatum ● Lieferdatum ●
Date de livraison ● Data di consegna ● Fecha de
Endrega ● Leveringsdato ● Leverings dato:
.………………………………………………………….
Buyer’s address
● Adres koper ● Kundenanschrift ● Adresse du client ● Indirizzo
del cliente ● Dirección del kliente ● Kjøpers adresse ● Købers adresse :
.…………………………………………………………………………………………………
………………………………………………………………………………………………….
Telephone
● Telefoon ● Telefon ● Téléphone ● Teléfono ● Telefon ● Telefon nr:
...……………………..……............................................................................................
Sales receipt date
● Aankoopbewijs -Datum ● Kaufbeleg-Datum ● Date du
récépissé ● Data prova d’acquisto ● Fecha recibo ● Kvitteringsdato ● Kasse bons
dato:…….…...………………………………………………………………………………...
Forwarder:
□
Pick-up
□
Others
● Door:
□
Verzending
□
Zelf afhalen
□
Spedition
□
Selbstabholer ● Par:
□
Transporteur
□
Propres moyens ● Tramite:
□
Spedizioniere
□
Mezzo proprio ● Entrega:Transporte organizado
□
transporte
propio ● Transportør:
□
Sendes
□
Hentes ● Transportør:
□
Sendes
□
Hentes
Description of complaint
● Beschrijving van de klacht ● Schilderung der Beanstandung ● Déscription de la réclamation ● Descrizione
della reclamazione ● Descripción del problema ● Beskrivelse av feil/ mangel ● Beskrivelse af fejl / Mangel:
Please keep the parts which
are the object of the complaint until the complaint is settled!
● Gelieve de betrokken onderdelen te bewaren tot de klacht is
afgehandeld ● Veuillez garder les pièces contestées jusqu’à ce que la réclamation soit traitée définitivement! ● Si prega di conservare i
pezzi reclamati fino all’evasione della reclamazione! ● Por favor, conserve las piezas objeto de la queja hasta que el problema haya sido
resuelto ● Please Vær vennlig å ta vare på de aktuelle delene/ produktet inntil saken er avsluttet! ● Venligst ta hånd om de aktueller dele /
produkt indtil sagen er afsluttet!
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Содержание FRB28-2524
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